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5 results

  • Chapter 9 - Dizziness

  • from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 108-130

  • Summary

    The evaluation of patients with the complaint of “dizziness” is a frequent occurrence in the ED. It accounts for 3.5–11% of ED visits. The word dizziness is a nonspecific term used by patients and healthcare professionals to describe a disturbed sense of wellbeing, usually perceived as an altered orientation in space. Vertigo is defined as an illusion of movement of oneself or one’s surroundings. It is usually experienced as a sensation of rotation or, less frequently, as undulation, linear displacement (pulsion), or tilt. Although vertigo usually suggests a vestibular disorder that can involve the inner ear or brain, this symptom itself cannot reliably localize the disorder. Dizziness or vertigo can result from numerous disorders of a complex human balance system. Despite the inherent complexities, the ED evaluation of dizziness or vertigo can be simplified by a systematic approach in history-taking, physical examination, and laboratory testing.

  • Investigation of seasonal variability of vestibular neuronitis

  • P D Koors, L R Thacker, D H Coelho
  • Journal:
    The Journal of Laryngology & Otology / Volume 127 / Issue 10 / October 2013
    Published online by Cambridge University Press:
    24 September 2013, pp. 968-971
    Print publication:
    October 2013
  • Objective:

    To determine if the incidence of vestibular neuronitis displays seasonal variation.

    Methods:

    A retrospective case review was performed to determine the monthly and quarterly incidence of vestibular neuronitis over a 36-month period. Incidence values were compiled, and the chi-square test and Rayleigh test for circular means were used to assess for uneven distribution and seasonality, respectively.

    Results:

    Fifty-two patients were diagnosed with vestibular neuronitis during the study period. The 2009–2010 study year showed uneven distribution and evidence of seasonality (R = 7.211, p < 0.001). However, the other two study years did not show statistical significance using either the chi-square test or Rayleigh test. In addition, when incidence values were aggregated across all three years of the study, neither the chi-square test nor Rayleigh test showed statistical significance.

    Conclusion:

    The present study found minimal evidence of seasonality in the incidence of vestibular neuronitis. These findings are consistent with studies of seasonality observed for other inner-ear disorders thought to be virally mediated.

  • Ocular and cervical vestibular evoked myogenic potentials in response to bone-conducted vibration in patients with probable inferior vestibular neuritis

  • L Manzari, A M Burgess, I S Curthoys
  • Journal:
    The Journal of Laryngology & Otology / Volume 126 / Issue 7 / July 2012
    Published online by Cambridge University Press:
    15 May 2012, pp. 683-691
    Print publication:
    July 2012
  • Background and aims:

    Previous evidence shows that the n10 component of the ocular vestibular evoked myogenic potential indicates utricular function, while the p13 component of the cervical vestibular evoked myogenic potential indicates saccular function. This study aimed to assess the possibility of differential utricular and saccular function testing in the clinic, and whether loss of saccular function affects utricular response.

    Methods:

    Following vibration conduction from the mid-forehead at the hairline, the ocular n10 component was recorded by surface electromyograph electrodes beneath both eyes, while the cervical p13–n23 component was recorded by surface electrodes over the tensed sternocleidomastoid muscles.

    Results:

    Fifty-nine patients were diagnosed with probable inferior vestibular neuritis, as their cervical p13–n23 component was asymmetrical (i.e. reduced or absent on the ipsilesional side), while their ocular n10 component was symmetrical (i.e. normal beneath the contralesional eye).

    Conclusion:

    The sense organ responsible for the cervical and the ocular vestibular evoked myogenic potentials cannot be the same, as one response was normal while the other was not. Reduced or absent saccular function has no detectable effect on the ocular n10 component. On vibration stimulation, the ocular n10 component indicates utricular function and the cervical p13–n23 component indicates saccular function.

  • Relevance of plasma D-dimer measurement in patients with acute peripheral vertigo

  • Bruno Fattori, Francesco Ursino, Renza Cristofani, Fabio Galetta, Andrea Nacci
  • Journal:
    The Journal of Laryngology & Otology / Volume 117 / Issue 6 / June 2003
    Published online by Cambridge University Press:
    08 March 2006, pp. 467-472
    Print publication:
    June 2003

  • The aetiopathogenesis of acute unilateral peripheral vestibular dysfunction (APV), also known as vestibular neuritis, is still debated: the principal cause is viral infection with vascular factors second in importance.

    Plasmatic D-dimer, considered a plasmatic index of hypercoagulation, was measured in a group of 45 APV patients and in a group of 25 patients suffering from Ménière’s disease. Measurements were taken both during the acute stage and after a four to six week period of pharmacological washout. The mean D-dimer levels were significantly higher than those measured in the controls both during the acute phase (301 SD161 vs 202 SD113 ng/mL) and after follow up (304 SD211 vs 192 SD111 ng/mL) (p = 0.008). Moreover, during the acute stage 23 of the APV patients (51.1 per cent) had plasmatic D-dimer levels above the upper normal limit (i.e.: <300 ng/mL), compared to four of those with Ménière’s disease (16 per cent).

    Our results lead us to postulate an involvement of the haemostatic system in APV.

  • Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery

  • Kentaro Ochi, Toru Ohashi, Shoji Watanabe
  • Journal:
    The Journal of Laryngology & Otology / Volume 117 / Issue 2 / February 2003
    Published online by Cambridge University Press:
    08 March 2006, pp. 104-108
    Print publication:
    February 2003

  • The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.